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jackyj888 t1_jdcf2ii wrote

Reply to comment by Nimelennar in (Biology) How far down your spine can you break before respiratory impairment? by Anomaly-Friend

Is that still taught? I would advise against it. Call 911 or a trusted family member/spouse of the effected person.

Giving insulin to someone with low blood sugar is generally worse than giving sugar to someone with high blood sugar, but you can still really do damage and even put someone into DKA if you don't know what you are doing.

Typically a glucometer is gonna be right next to the insulin or in a diabetics medical supplies. Use it and give the 911 operator the result and right it down next to the time you took the reading for the arriving ambulance.

If they are unconscious, don't try to put food or water in their mouth. They either need an IV or insulin, and both are jobs for trained pros. In the event of a diabetic emergency, neither dextrose/glucose or insulin should be given without a glucometer reading.

Tldr: If you aren't a paramedic or higher, you shouldn't be administering insulin or dextrose/glucose either way.

Otherwise your post seems pretty accurate. Not trying to crap on or dismiss your post or anything, just saying that that is no longer recommended.

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ilikeyourjacket t1_jdcj45q wrote

Unlikely to put someone into DKA by giving them sugar as it's the lack of insulin that precipitates DKA rather than excess of sugar. But otherwise agree, important not to give unconscious person food.

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Nimelennar t1_jdcmpd5 wrote

>Is that still taught?

Unless things have changed in the past year or so, since I last took a course.

>Call 911 or a trusted family member/spouse of the effected person.

Yes, if someone is in obvious enough distress that you're concerned about either hyperglycemia or hypoglycemia, you're going to want to get help to them. I should have mentioned that.

>Typically a glucometer is gonna be right next to the insulin or in a diabetics medical supplies.

Sure, but as a first aider, you're not typically trained to use it. I mean, it's not rocket science, but (IANAL, just someone who has taken a lot of first aid courses) Good Samaritan laws only tend to protect you within the scope of your training, and for anything you do outside of that training (like taking even a tiny blood sample), you can be held liable for if things go wrong.

Of course, if the 911 operator instructs you to, that's fine (at that point, you're acting under their authority, rather than your own as a first aider), but it's not something I'd recommend taking initiative on.

>If they are unconscious, don't try to put food or water in their mouth.

I was taught this is the only exception to that rule; a small amount of sugary gel (e.g. honey or icing), deposited in the cheek.

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ilikeyourjacket t1_jdcp1bw wrote

Hmmm I think I would be wary putting something in the mouth of someone who is completely unconscious as they have a high risk of aspirating because they lose their protective airway reflexes.

But by all means if someone has reduced consciousness but they’re still able to swallow then we essentially use exactly that in the hospital context: a sugary gel as first line treatment of hypoglycaemia.

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Nimelennar t1_jdctp7t wrote

I think that's the rationale behind putting it in the cheek (i.e. between the teeth and the lips), and of using a gel instead of a less viscous liquid like a juice: to minimize the risk of aspirating it.

At least one first aid instructor I've had has suggested running the gel into the flesh of the lips and gums, which should reduce that risk even further, but I don't think that was ever a formal part of the training.

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jackyj888 t1_jddjksx wrote

You are correct. It is absolutely against common medical teaching and 99% of prehospital protocols to put glucose paste or anything else in the mouth of an unconcious diabetic. Altered LOC, sure, but not unconcious.

I'm sure you also know as a nurse that it would be absolutely a bad idea to start administration of sugar or insulin prior to obtaining blood glucose.

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jackyj888 t1_jddj23y wrote

>Sure, but as a first aider, you're not typically trained to use it. I mean, it's not rocket science, but (IANAL, just someone who has taken a lot of first aid courses) Good Samaritan laws only tend to protect you within the scope of your training, and for anything you do outside of that training (like taking even a tiny blood sample), you can be held liable for if things go wrong.

It's more in scope than administration of sugars or insulin to a diabetic, which is typically a medic though sometimes an EMT skill.

Ting a first aid course or being first aid certified doesn't even include a scope of practice anyways.

>Of course, if the 911 operator instructs you to, that's fine (at that point, you're acting under their authority, rather than your own as a first aider), but it's not something I'd recommend taking initiative on.

Again, you can get someone killed by administration of sugar or insulin, and administration of sugar or insulin is beyond first aiders/Emr anyways.

Unlike using insulin or sugar, using a glucometer poses 0 risk to the patient unless you somehow manage to miss the finger and poke them in the eye or something.

>I was taught this is the only exception to that rule; a small amount of sugary gel (e.g. honey or icing), deposited in the cheek.

Big no no. Absolutely do not do this and this hasn't been recommended for like over 20 years, at least in the USA. An unconcious diabetic needs a line, not stuff put in their mouth.

Source: Degree in Paramedicine, and a career working as a medic on the ambulance.

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TeeDeeArt t1_jdh8wd7 wrote

> Tldr: If you aren't a paramedic or higher, you shouldn't be administering insulin or dextrose/glucose either way.

Quickly checked current Australian and uk first aid resources (red cross training), and they do still seem to recommend that first aiders do it (giving sugar/sugary foodndrink) assuming the diabetic person is still responsive. I'd maybe be a bit more careful with wording when giving medical advise or first aid training online without being very specific as to where it applies.

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